To place this discussion in context, the development of patientbased
measures of health outcomes, in both medicine and
dentistry, should be seen as part of a broad paradigm shift in
health care in which the medical model has been modified, if not
replaced, by the socioenvironmental model of health.10 The
socioenvironmental model, which provides the basis for health
promotion theory and practice,11 involves a change in our thinking
about what constitutes health and the strategies necessary to
produce it